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APPLICATION FOR SANITATION PERMIT Permit No.-._..H. .....Ak 1 (Complete in Duplicate) G/ — Date issued .._- -- ----------- Applica}ion is hereby made to the San Joaquin Local Health District for a permit o cgfstr ct a install the work herein described. This application is made in compliance with County Ordinance No. 549. 6 q5 L '�/ar Da, JOB ADDRESS AND LOCATION V" �Op 9 Owner's Name _/.7c-a��- - - --- ------- Phone-.- �/ Address ---7� `•-;_40 ; 6 r1 - ---- -- - - -----------`-�-------------------------------- - - ------------- - _ Phone? 4 T/>-.__ Contractor s Name---------------------- f e 6 a , Installation will serve: Residence X Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms�--- Number of baths _/---- Lot size :�d4_ .__X.lQ1L �.----------------------- Water -__--------------- --Water Supply: Public system ❑ Community system ❑ Private 9 Depth to Water Table' / ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ Previous Application Made: Yes ❑ No New Construction; Yesx No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �+ C i� Septic Tank: Distance from nearest well_-s=1 �_-.__Distance from foundation__ U_._._---Mat ria6---------------------------------------------- -. No. of compartments------Z--------------- ........Liquid depth------- ---,lel--------Capacity--- Disposal Field: Distance from nearest weiL.�P� -_ __Distance from foundation-_ to nearest lot line_/d...____. Number of lines-------�-_-_____- _..._. Length of each line...... d_:'_--.,-.----.Width of french....a? " Type of ._.. filter material.__ e-__ . .._ _ _._Depth of filter material--- ------ --------Total length------7-,5"c _-____________ Seepage Pit: Distance to nearest well.-/-----------Distance from�found tian__�B__�_____.Distan�e to nearest Jot fine-,-5___�____ �V~ Number of pits.___-l------------Lining materials_�_. Diameter.__ --- cis Depth _-�-�------------- -- Cesspool: Distance from nearest well-----------------Distance from foundation-- ----..-.---_-_..Lining material--------------------- --- _--------- ❑ Size: Diameter------- ------------------------------Depth----------------------------------- ---------------Liquid Capacity----------------- ---.gals. Privy: Distance from nearest well----------------_____--____-_-_._._.--._--.-.---Distance from nearest building-----------__.------------------------ . ❑ Distance to nearest lot line------------- ----- - ----- - -------------- -- ------•----•-••------ -------------------------•------•------ M Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------.------------------------------------- ------------- ---------------- -----------•-------•- ----------- ---------•------------------=---------------------------•----------•------------------------------------•------•------- ------------•---------••------------------•-------------------- - ! I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ,. te, laws, and rules and regulations of the San Joaquin Local Health District. J [Signed) _ ----------I----------------- --------------- (Owner and/or Contract t By: 1-+%� �*- /-- -----------------------------------------------------(Title)- T� `-- -'--------------------- ------- f (Plot plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ---------- DATE-------------------------- c == ` REVIEWEDBY------------------------------------------- - --- - --- ------------------------.---------------------------------- DATE-------------------.-- ---J t BUILDING PERMIT ISSUED--------------_--------- ---- -- ----- ---------------------------------------------- -•----------- DATE-------- / Alterations and/or recommendations:------------ --- ------ ---- - -- ------------------------------------•---•--------------------- -----------_--- -_---•-•----•-----•---------•------- i t. -------- ------------- -------- ----------- --------------•-•--•--•--------- 1�•• •--------------------. ----•----------- *> _ --�: _ - ------------ ------ -------------------- ---- --- - ---------------------- -- -- --------------------------------------------------------- --- ----------------------- --------------- -------------------- FINAL INSPECTION BY:------ —P- ------ Date--.._- .- �" --------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E 5-9 145446 ATWCOD